Little attention has been paid to iatrogenic disorders in psychiatry

In an article published in the current issue of Psychotherapy and Psychosomatics, Giovanni Fava and Chiara Rafanelli badyze the literature on iatrogenic disorders in psychiatry, which may be due to drugs or psychotherapy.

Side effects and risks badociated with medical intervention are defined as iatrogenesis. In psychiatry, iatrogenesis has traditionally been badociated with the medical complications of psychotropic drug treatment. As with medical treatment, the side effects of psychiatric treatments have been conceived as the inevitable drawbacks of any form of medical treatment. Little attention has been paid to the adverse psychological and behavioral effects of psychiatric treatment on psychopathology and the course of the disease.

Current clbadification systems in psychiatry do not take into account the iatrogenic components of psychopathology related to behavioral toxicity. Emotional disorders caused by drugs, as well as paradoxical effects, manifestations of tolerance (loss of clinical effect, refractory), withdrawal disorders and post-weaning disorders are more and more frequent due to the widespread use of psychotropic drugs in the general population. Such negligence is serious because manifestations of behavioral toxicity are unlikely to respond to conventional psychiatric treatment and may be responsible for the broad spectrum of disturbances included in the generic topic of resistance to treatment. The term "iatrogenic comorbidity" refers to adverse changes in the course, characteristics and responsiveness to treatment of a disease that may be related to previously administered treatments. Such modifications may also lead to serial development of multiple medical and psychiatric complications (cascade iatrogenesis).

The notion of psychiatric illness is no longer in tune with the changing spectrum of health and the complex interaction of biological, iatrogenic and psychosocial factors. Consideration of iatrogenic factors calls into question most of the current practice of prescribing psychotropic drugs. Currently, the prescribing physician is guided by evidence-based medicine and guidelines, the marketing arm of the pharmaceutical industry, which overestimates the potential benefits, pays little attention to the likelihood of responsiveness and overlooks potential vulnerabilities adverse effects of treatment.

The authors concluded by pointing out that the long-term consequences of psychiatric disorders may not be satisfactory, not because technical interventions are lacking, but because our conceptual models that ignore iatrogenic forms of psychopathology are inadequate.